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The injury poverty trap in rural Vietnam: causes, consequences and possible solutions
Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The focus of this study is the vicious circle of poverty and ill-health. The case is injuries but it could have been any lasting and severe disease. Poverty and health have very close links to economic development and to how health care is financed. Out-of-pocket payment seems to increase the risk of poverty while prepaid health care reduces it. The overall objective is to investigate the “injury poverty trap” and suggest possible solutions for it. A cohort of 23,807 people living in 5,801 households in Bavi district of Vietnam was followed from 1999 to 2003 to investigate income losses caused by non-fatal unintentional injuries in 2000 as well as the relationships between social position in 1999 and those injuries. For the possible solutions, a survey in 2064 household was performed to elicit people’s preferences and willingness to pay for different health care financing options. The results showed that unintentional injuries imposed a large economic burden on society, especially on the victims. By two pathways – treatment costs and income losses – unintentional injury increased the risk of being poor. The losses for non-poor and poor injured households were about 15 and 11 months of income of an average person in the non-poor and poor group, respectively. Furthermore, poverty was shown to be a probable cause of non-fatal unintentional injuries. Specifically, poverty led to home injuries among children and the elderly, and adults 15 – 49 years of age were particularly at risk in the workplace. The middle-income group was at greatest risk for traffic injuries, probably due to the unsafe use of bicycles or motorbikes. About half of the population preferred to keep an out-of-pocket system and the other half preferred health insurance. People’s willingness to pay suggested that a community-based health insurance scheme would be feasible. However, improvements in the existing health insurance systems are imperative to attract people to participate in these or any alternative health insurance schemes, since the limitations of the existing systems were generalized to health insurance as a whole. A successful solution should follow two tracks: prepayment of health care and some insurance based compensation of income losses during the illness period. If the risk of catastrophic illness is more evenly spread across the society, it would increase the general welfare even if no more resources are provided.

Place, publisher, year, edition, pages
Umeå: Folkhälsa och klinisk medicin , 2005. , 182 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 990
Keyword [en]
unintentional injury, poverty, out-of-pocket payment, health insurance, Vietnam
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-627ISBN: 91-7305-958-7 (print)OAI: oai:DiVA.org:umu-627DiVA: diva2:144046
Public defence
2005-12-09, 09:00 (English)
Supervisors
Available from: 2005-11-16 Created: 2005-11-16 Last updated: 2010-01-29Bibliographically approved
List of papers
1. The economic burden of unintentional injuries: a community-based cost analysis in Bavi, Vietnam.
Open this publication in new window or tab >>The economic burden of unintentional injuries: a community-based cost analysis in Bavi, Vietnam.
2003 (English)In: Scandinavian journal of public health. Supplement, ISSN 1403-4956, Vol. 62, 45-51 p.Article in journal (Refereed) Published
Abstract [en]

AIMS: Relatively little is known about patterns of injury at the community level in Vietnam and their economic consequences. This study sought to estimate the costs of various unintentional injuries in Bavi District during one year; to describe how costs depended on gender, age, circumstances, and severity of injury; and to describe how the economic burden of unintentional injuries was distributed between households, government, and health insurance agency. METHODS: A cohort study was undertaken, which involved four cross-sectional household surveys among sampled communities in the Bavi District during the year 2000, each asking about injuries in the preceding three months. The costing system in public healthcare in Vietnam was applied as well as information from the victims. RESULTS: The total cost of injuries over one year in Bavi District was estimated to be D3,412,539,000 (Vietnamese dong) (US$235,347), equivalent to the annual income of 1,800 people. In total, 90% of this economic burden fell on households, only 8% on government, and 2% on the health insurance agency. The cost of a severe injury to the corresponded to approximately seven months of earned income. Home and traffic injuries together accounted for more than 80% of the total cost, 45% and 38% respectively. The highest unit cost was related to traffic injuries, followed by home, "other", work-related, and school injuries in descending order. DISCUSSION: The results can be considered as an economic baseline that can be used in evaluations of future interventions aimed at preventing injuries.

Keyword
unintentional injury, poverty, out-of-pocket payment, health insurance, Vietnam
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-29872 (URN)10.1080/14034950310015103 (DOI)14649638 (PubMedID)
Available from: 2009-11-25 Created: 2009-11-25 Last updated: 2015-04-29Bibliographically approved
2. Does poverty lead to non-fatal unintentional injuries in rural Vietnam?
Open this publication in new window or tab >>Does poverty lead to non-fatal unintentional injuries in rural Vietnam?
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2005 (English)In: International Journal of Injury Control and Safety Promotion, ISSN 1745-7300, Vol. 12, no 1, 31-37 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to identify associations between poverty at the household level and unintentional injury morbidity. A cohort consisting of 24,874 person-time episodes, representing 24,776 people living in 5,801 households (classified into rich, middle income and poor by local authorities in 1999) was followed during 2000, in order to identify and assess non-fatal unintentional injuries. Incidence rate ratios were calculated using a Poisson regression model. The results showed that poverty was a risk factor for unintentional injuries generally. When looking at different types of injury, poverty was a risk for home, work and "other" injuries, protective for school injuries, while the risk of traffic injuries was not affected. The results also showed that communes in mountainous areas were at higher risk for home, work and other injuries. Overall, poverty was associated with unintentional injury morbidity. However, the relationship varied by sex, age and type of injury. Specifically, poverty increased the risk for children and elderly people being injured at home, and for adults (15-59 years) being affected by work injuries.

Keyword
Adolescent, Adult, Age Distribution, Aged, Child, Cluster Analysis, Cohort Studies, Developing Countries, Female, Humans, Incidence, Male, Middle Aged, Poisson Distribution, Poverty, Risk Factors, Rural Health, Sex Distribution, Vietnam/epidemiology, Wounds and Injuries/epidemiology/*etiology
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-13885 (URN)10.1080/17457300512331342207 (DOI)15814373 (PubMedID)
Available from: 2007-05-16 Created: 2007-05-16 Last updated: 2015-04-29Bibliographically approved
3. Does "the injury poverty trap" exist? A longitudinal study in Bavi, Vietnam.
Open this publication in new window or tab >>Does "the injury poverty trap" exist? A longitudinal study in Bavi, Vietnam.
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2006 (English)In: Health Policy, ISSN 0168-8510, Vol. 78, no 2-3, 249-257 p.Article in journal (Refereed) Published
Abstract [en]

In this study we concentrate on injuries and affected households' capacities to earn incomes. A longitudinal study was performed in Bavi district, Vietnam, with the specific objectives to investigate: (1) the affects of injuries on incomes by comparing income changes in injured and non-injured individuals; (2) the affect of injuries on social mobility by estimating households' relative risk of dropping into poverty for households with and without injuries and estimating the relative risk of escaping from poverty for households without and with injuries. The propensity score matching method using a logit model was used for data analysis. The results show that on average, the loss per household is estimated at VND 1,084,000 (USD 72) for poor and VND 2,598,000 (USD 173) for non-poor, equivalent to 11 (9) and 15 (13) working months of an average person in the poor and non-poor group, respectively, during 1999 (2001). The relative risk of dropping into poverty for non-poor households with and without injuries equal to 1.21 (p=0.08) and the relative risk of escaping from poverty between poor households without and with injuries equal to 0.96 (p=0.39). In conclusion, it has been argued that the introduction of user fees created a poverty trap and thus their removal may be a solution. However, user fees are only a part of the burden on households. Loss of income during the illness period is likely to be a problem of the same magnitude. A successful solution must thus follow two tracks: prepayment of health care and some insurance based compensation of income losses during the illness period. Both reforms, if they are persistent, must be done within the resource limits of the local society. If the risk of catastrophic illness is more evenly spread across the society, it would increase the general welfare even if no more resources are provided.

Keyword
Data Collection, Female, Humans, Income, Longitudinal Studies, Male, Poverty, Vietnam, Wounds and Injuries/*economics
Identifiers
urn:nbn:se:umu:diva-16191 (URN)10.1016/j.healthpol.2005.10.003 (DOI)16290127 (PubMedID)
Available from: 2008-10-07 Created: 2008-10-07 Last updated: 2015-04-29Bibliographically approved
4. People’s preferences for health care financing options: a choice experiment in rural Vietnam
Open this publication in new window or tab >>People’s preferences for health care financing options: a choice experiment in rural Vietnam
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(English)Manuscript (preprint) (Other academic)
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-4802 (URN)
Available from: 2005-11-16 Created: 2005-11-16 Last updated: 2017-03-27Bibliographically approved
5. People's willingness to pay for health insurance in rural Vietnam
Open this publication in new window or tab >>People's willingness to pay for health insurance in rural Vietnam
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2008 (English)In: Cost Effectiveness and Resource Allocation, ISSN 1478-7547, Vol. 6, 16- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The inequity caused by health financing in Vietnam, which mainly relies on out-of-pocket payments, has put pre-payment reform high on the political agenda. This paper reports on a study of the willingness to pay for health insurance among a rural population in northern Vietnam, exploring whether the Vietnamese are willing to pay enough to sufficiently finance a health insurance system.

METHODS: Using the Epidemiological Field Laboratory for Health Systems Research in the Bavi district (FilaBavi), 2070 households were randomly selected for the study. Existing FilaBavi interviewers were trained especially for this study. The interview questionnaire was developed through a pilot study followed by focus group discussions among interviewers. Determinants of households' willingness to pay were studied through interval regression by which problems such as zero answers, skewness, outliers and the heaping effect may be solved.

RESULTS: Households' average willingness to pay (WTP) is higher than their costs for public health care and self-treatment. For 70-80% of the respondents, average WTP is also sufficient to pay the lower range of premiums in existing health insurance programmes. However, the average WTP would only be sufficient to finance about half of total household public, as well as private, health care costs. Variables that reflect income, health care need, age and educational level were significant determinants of households' willingness to pay. Contrary to expectations, age was negatively related to willingness to pay.

CONCLUSION: Since WTP is sufficient to cover household costs for public health care, it depends to what extent households would substitute private for public care and increase utilization as to whether WTP would also be sufficient enough to finance health insurance. This study highlights potential for public information schemes that may change the negative attitude towards health insurance, which this study has uncovered. A key task for policy makers is to win the trust of the population in relation to a health insurance system, particularly among the old and those with relatively low education.

Place, publisher, year, edition, pages
BioMed Central, 2008
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-10325 (URN)10.1186/1478-7547-6-16 (DOI)18691440 (PubMedID)
Available from: 2008-08-13 Created: 2008-08-13 Last updated: 2015-04-29Bibliographically approved

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